Congress should strengthen the powers of the director of the
National Institutes of Health (NIH) and reconsider the special
status and authority of the National Cancer Institute (NCI),
according to a National Academy of Sciences (NAS) committee that
assessed the organization and management of NIH. The congressionally
mandated study also recommended several mergers within NIH but did
not endorse a major restructuring of the agency, as some critics had urged.

The semi-independent status of the NCI has long been a sore point
with some people within NIH. Under the National Cancer Act of 1971,
the NCI director, unlike other institute and center directors, is appointed
by the President and approved by the Senate. Moreover, the NCI
budget goes directly to the White House

"Because the President appoints the NCI director and the NCI
budget bypasses the NIH director, it is possible that an unnecessary rift
is created between the goals, mission, and leadership of NIH and those
of NCI," the committee said. Therefore, "Congress should reassess the
provisions of the National Cancer Act of 1971, particularly as they
affect the authority of the NIH director to hire senior management and
plan and coordinate the NIH budget and its programs in their entirety."